Pamantasan ng Lungsod ng Marikina

2 Brazil St., Greenheights Subd., Concepcion Uno, Marikina City

College of Health Sciences

NCM 104 RLE

FAMILY NURSING CARE PLAN

Group 12

Pineda, Strawberry C.
Ramos, Loella B.
Rea, Maryelle Leila P.
Rivera, Shaina Andrea L.
Salamat, Jashiel Cassandra E.
Santos, Angela Segui, Elaine
Sicsic, Ma. Monette B.
Ting, Jen Shenry T.
Tolentino, Brian R.
Tolentino, Rica Ella C.
Vargas, Ashley Yzabelle C.
Zerna, Sophia Anne A.
Zulueta, Sofia Yamani Rayden

Professor Maria Katrina Orbista, MAN, RN

December 2022
 Table of Contents

Part 1: Family Profile

I. Family Profile.............................................................................................

II. Top 3 Family Health Problems............................................................................

III. Prioritization of Health Problems Identified

Part 2: Family Nursing Care Plan

IV. Background of the Problem .................................................................................

V. Family Nursing Diagnosis............................................................................

a. Diagnosis...........................................................................................

b. Problem Tree Analysis .......................................................................

VI. Family Nursing Care Plan..........................................................................................

VIII. Health Teaching Plan.............................................................................................

References.........................................................................................................................

Appendices........................................................................................................................

Appendix 1: Informed Consent............................................................................

Appendix 2: Interview Form................................................................................

Appendix 3: Consolidated Interview Results.................................................................

PART 1: Family Profile

I. Family Profile

Table 1. Demographic Profile, Family Parinas and Villanueva, Barangay Malanday, Marikina City, October 2022

The table summarizes each of the family member’s demographic profiles for the Mother, Rose Ann
Parinas; Father, Allyson Villanueva; Gian Coullomar, 1st child; Radson Villanueva, 2nd child, and; Ariana
Villanueva, a newborn.

Table 1.1. Demographic Profile, Family Parinas and Villanueva, Barangay Malanday, Marikina City, October 2022
A. Socio-Economic and Cultural Values

a. Social Indicators

The family has been living in Malanday, Marikina City for three years. They are living on

an apartment lease which has a living room, kitchen, dining room, and three bedrooms with

windows. The five members of the family occupy one room and share a common bathroom with

other renters. They do not have access to an internet connection and frequently lose signal from

their phone. Furthermore, there are no encounters of any disagreement with their neighbors and

maintains a good relationship with them.

The family maintains their apartment by frequent sanitation through cleaning and

checking their drainage canal system once a week. Although the renters do not have access to

a water closet, they instead use a bucket of water to flush down the toilet. Even so, the

presence of cockroaches, rats and mosquitoes are noticeable, especially in canals, dumpsites,

and ceilings. Fumigations and insecticides are used occasionally to counter these problems but

most of the time they only use slippers to get rid of them.

In times of emergency and illness, the family visits public hospitals and their local

barangay health center which is only a walking distance from their apartment. Like most Filipino

households, they use public vehicles such as tricycles and jeepneys as their mode of

transportation.

They do not belong to any organizations nor engage in community seminars or projects

related to the health community. Their family is not part of any barangay councilors, but they are

willing to take part in community health and sanitation activities to join as volunteers that

promote a healthy lifestyle.

 b. Economic Indicators

The family belongs to the Low Income But Not Poor (LINP) social class with an income

of 10,957php to 21,914php monthly. Their expenses range from 8,000php to 12,000php

monthly, with their utility bills, children’s education, family’s food, and rent being their top

priorities when budgeting. The father’s income hardly fulfills these expenses due to his job’s

irregularity. Even so, the family is not receiving any external financial assistance, but they have

PhilHealth Insurance.

c. Environmental Indicators

The Villanueva family resides beside a river in Marikina, an urban city. According to Ms.

Pariñas, they are aware of their community's environmental hazards, mainly flooding. Their

neighborhood typically experiences rainy weather. The family uses Manila Water as their water

source, and they never experience frequent interruptions in the water supply. They drink from

Commercially-prepared water such as mineral water, and occasionally, from tap water. There is

evident trash and litter in their area, but the family strictly practices waste segregation into

biodegradable, non-biodegradable, and recyclable materials. Their garbage bins are covered,

and they dispose of their trash twice a week.

d. Cultural Factors

The whole family is Roman Catholic, but they do not follow any religious practices. Some

family members usually catch coughs and colds, and when this happens, their first approach in

certain situations when one of them gets sick is self-medicating and visiting the health center.
Self-medication is defined as individuals selecting and using medicines to treat self-recognized

or self-diagnosed conditions or symptoms. Furthermore, they also make use of Luyang dilaw or

Turmeric as herbal medicine to treat simple illnesses.

B. Health and Illness Patterns

a. History of Immunizations

Table 2. History of Immunizations: Family Parinas and Villanueva, Barangay Malanday, Marikina City, October 2022

Table 2 summarizes each of the family member’s immunizations. Both parents are

immunized against COVID-19 and no mentions of other vaccines taken. Flu, Tetanus, Hepatitis

A, Hepatitis B, Measles, Mumps, Rubella (1st and 2nd dose), Pneumococcal, Diphtheria, Pollo,

and Whooping cough vaccinations, for both 1st and 2nd child have all been received. Hepatitis

B vaccine and BCG vaccine for the newborn baby of 3 weeks have been received. The family

did not travel, did not have interaction with Covid-19 patients, and did not have any symptoms in

the past 14 days.

 b. Past and Present Health Concerns and Conditions

The family doesn't have any reported past or present health concerns and conditions

aside from experiencing seasonal flu.

c. Diagnosed Conditions

None of the family members are diagnosed with any condition.

d. Maintenance Medications

No maintenance medications taken.

e. Hospitalizations

Only Ms. Parinas had a recent hospitalization on October 18, 2022, when she gave birth

to her 3rd child.

C. Pediatric Health

a. Vital Data of Children

Ms. Pariñas gave birth to her second child, a baby boy named Radson, at East Avenue

Medical in Quezon City on October 24, 2019, and delivered the youngest child named Ariana

last October 18, 2022, at Marikina City's Amang Rodriguez Memorial Medical Center.

b. Pregnancy Data
 The duration of Ms. Pariñas’ pregnancy with her 1st and 2nd born were both 38 weeks,

with no complications. While on her 3rd pregnancy, which lasted for 39 weeks, Ms. Pariñas

experienced a complication- cervical prolapse, in the ninth month before delivery.

c. Delivery Data

Ms. Pariñas’ 3rd child was born through an emergency cesarean section due to cervical

prolapse during labor. The baby weighed 2.9 kg and measured 49 cm, with no reports of further

complications. There are no records of when Ms. Parinas's first and second children were born.

d. Breastfeeding Data

Ms. Pariñas immediately began breastfeeding the second child after delivery but had to

stop at six months because of the insufficient amount of milk. As a result, they used formula milk

as an alternative. Meanwhile, the mother started breastfeeding the youngest baby five days

after the delivery and has continued up to this day. The client breastfeeds the newborn 4-6 times

per day with no complications.

D. Family Planning

Among the contraceptives available, Ms. Parinas opted to use IUD (Intrauterine Device)

as their family planning method.

E. Health Lifestyle and Activities

 Regarding the family’s health and lifestyle activities, only the father is actively doing

exercise, which is biking twice a week. He does not smoke traditional cigarettes but smokes

e-cigarettes and drinks alcohol occasionally.

F. Nutritional Status

All family members have a BMI (body mass index) that falls within the normal range.

Regarding food sanitation, they store ingredients on the table both before and after cooking.

Usually, the mother cooks the family’s meal, and as part of her preparation, she always

observes handwashing. Cooking food by boiling is usually the preferred method.

As for the family’s food intake, they also consume unhealthy foods such as junk food,

processed foods, and soft drinks. They eat three to five times per day, and the usual foods that

they prepare for each meal are bread, rice, and coffee for breakfast; rice is accompanied by

different dishes for lunch and dinner; and for their snacks, they usually have kakanin and coffee.

When it comes to the type of food they eat and how frequently they eat it, vegetables and

seafood are what they eat the most in a week, about 3-5 times, while red meat, chicken, and

fruits are prepared 1-2 times per week. They do not use seasonings in their food preparation,

and no one in the family is allergic to any specific food.

In terms of drinking water sanitation, the family uses methods such as filtration or

purchases commercially prepared water, which they store in covered containers.

G. Health Resources

As health advocates, the interviewers inquired about the mother's primary source of

health information, which they responded to with the help of the barangay health workers. In

addition, the mother consults with a healthcare professional and watches television programs or

listens to radio programs when she wants further information about health-related concerns.

The mother makes sure that their sources for health education are reliable by checking

them against other reliable sources.

II. Top 3 Family Health Problems

1. Potential for Enhanced Capability for Breastfeeding

According to WHO and UNICEF, it is recommended that children initiate

breastfeeding within the first hour of birth and be exclusively breastfed for the first

six months. The mother has a history of stopping breastfeeding early, with her 1st

child at one year and her 2nd child at six months only. Now, the mother has a

newborn, which she gave birth to on October 18, and it would be beneficial for

both mother and child to have health teachings on enhanced capability for

breastfeeding.

2. Presence of Health Threats related to History of Childbirth Complication

due to Cervical Prolapse

The mother anticipated a normal delivery during her recent childbirth but

unfortunately led to an emergency cesarean section due to Cervical Prolapse

during labor. According to WHO, complications from delivery are one of the major
 complications that account for nearly 75% of all maternal deaths. Taking action

on the mother’s history of childbirth complications can lessen the gravity of

symptoms and risks it imposes on the mother’s health.

3. Unhealthful Nutritional/Eating Habits

Like many other average families, the family is not aware and does not utilize

some of the local nutrition programs such as Pinggang Pinoy. Their daily meals

are usually only composed of meat, and fruits can only be consumed 1-2 times

per week. The family also consumes junk foods and soft drinks. These are not

considered as complete and nutritional diets where especially their 3 year old

child and newborn’s nutrition are dependent on. According to the World Health

Organization (WHO), undernutrition is estimated to be associated with 2.7 million

child deaths annually, or 45% of all child deaths.

The top three selected family health issues were filtered. It focuses on Maternal and

Child Health Nursing, and is aligned with Sustainable Development Goal No. 3 (SDG 3): Good

Health and Well-Being, which focuses on ensuring healthy lives and promoting well-being for all

people of all ages. In particular,, it is aligned with Targets 3.1 Reduce Mortality Rate; 3.2: End all

preventable deaths in children under 5; and 3.7: Universal Access to Sexual and Reproductive

Health Care, Family Planning, and Education.

III. Prioritization of Health Problems Identified

Table 3. Scale for Ranking Health Conditions and Problems According to Priorities

Criteria Weight
 1. Nature of the condition of problem 1
presented
Scale **: wellness state 3
health deficit 3
health threat 2
foreseeable crisis 1

2. Modifiability of the condition or problem 2

Scale **: easily modifiable 2
partially modifiable 1
not modifiable 0

3. Preventive potential 1
Scale **: high 3
moderate 2
low 1

4. Salience 1
Scale **: a condition or problem, 2
needing immediate attention

a condition or problem not 1

needing immediate attention

not perceived as a problem or 0

condition needing change

A. Potential for Enhanced Capability for Breastfeeding

Criteria Computation Actual Justification

Score

1. Nature of 3/3 x 1 1 The nature of the problem concerns wellness status, as

the breastfeeding provides unmatched health benefits for infants. In this
Problem case, the mother of a newborn has a history of stopping
breastfeeding early with her first two children due to an insufficient
supply of milk. Such cases can result in the lack of nutrition acquired
by infants. According to the WHO (2021), undernutrition is estimated
to be associated with 2.7 million child deaths annually, or 45% of all
child deaths. And only about 44% of infants aged 0–6 months
worldwide were exclusively breastfed over the period of 2015-2020.
The first 2 years of a child’s life are particularly important, as optimal
nutrition during this period lowers morbidity and mortality, reduces
the risk of chronic disease, and fosters better development overall.
 Sources:
(WHO, 2021)
https://www.who.int/news-room/fact-sheets/detail/infant-and-young-c
hild-feeding

The mother stopped breastfeeding her first child at 1 year and 6

2. Modifiability 2/2 x 2 2 months and her second child at 6 months. Early stopping in
of the breastfeeding is modifiable through ways and technique and proper
Problem health teaching.

Breastfeeding rates in many developed countries remain low, and

maternal perception of insufficient milk production is a major
contributing factor. Mothers with a perception of insufficient milk
should be advised that normal breastfeeding frequencies, suckling
times, and amounts are very variable. If objective assessment
confirms insufficient milk production, mothers should ensure optimal
milk removal frequency and thorough breast drainage. In addition,
galactagogues can be prescribed.

Sources:
Kent. J, et.al (2012)
https://www.jognn.org/article/S0884-2175(15)31026-1/fulltext

The problem can be prevented if the mother is provided with the

3. Preventive 3/3 x 1 1 necessary information about the benefits of breastfeeding and is
Potential given a supportive environment that allows her to breastfeed her
child. Optimal breastfeeding has the potential to minimize 823,000
children and 20,000 maternal mortality more than any other
preventive measure, according to WHO and Unicef (2019). The first
two to three years of a child's life have a significant impact on their
future. For this reason, parents and caregivers are encouraged to
begin exclusive breastfeeding and continue it for at least the first two
years or longer to give sufficient nutrition to their children.

Sources:
Piojo, L.M., UNICEF Philippines (2019)
https://www.unicef.org/philippines/press-releases/hundreds-mothers-
gather-celebrate-national-breastfeeding-awareness-month

As per our data, it shows that the mother discontinued breastfeeding

4. Salience of 1/2 x 1 0.5 her first and second child at an early point. According to the Centers
the for Disease Control and Prevention (CDC), 60% of mothers do not
Problem continue breastfeeding as long as they intend to. Our findings
indicate that the mother discontinued breastfeeding because she had
difficulties with latching and lactating. Nevertheless, she does not
 consider that this requires attention immediately.

Sources:
CDC (2022)
https://www.cdc.gov/breastfeeding/data/facts.html

Total Score 4.5

B. Presence of Health Threats related to History of Childbirth Complication due to

Cervical Prolapse

Criteria Computation Actual Justification

Score

1. Nature of 2/3 x 1 0.67 The mother had cervical prolapse during labor that caused an
the Emergency Cesarean Section. According to Tsikouras, et al., It's not
Problem uncommon for uterine prolapse to appear during pregnancy in
pregnant women, whether it was there before or not. The problem
concerned is a health threat to both mother and infant since preterm
labor, maternal and fetal mortality, acute urinary retention, and
urinary tract infections are among the complications caused by
uterine prolapse in pregnancy, which range from a minor cervical
infection to miscarriage. Additionally, affected women may be
particularly vulnerable to developing dystocia during labor, which
could call for immediate delivery assistance.

Sources:
Tsikouras, et al.,(n.d.)
https://www.tandfonline.com/doi/abs/10.3109/14767058.2013.807235

2. Modifiability 1/2 x 2 1 The problem is partially modifiable since we also take into account
of the the gravity of cervical prolapse and the resources of the family for
Problem treatment. The key to reducing prolapse symptoms is being aware of
the activities that place downward pressure and strain on the uterus
and cervix. These are some ways to relieve prolapse symptoms:
Pelvic floor or Kegels exercise;
Wearing support briefs that are well fitted over the low abdomen
Usage of correct bowel emptying technique
Taking appropriate diet, fluid intake, and managing medication as
required, and; use of a support pessary.

Sources:
Kenway, M. (2021)
How to Avoid Your Uterine Prolapse Symptoms Worsening - Pelvic
 Exercises

3. Preventive 2/3 x 1 0.67 The problem has a moderate preventive potential since we
Potential considered the magnitude of possible complications that may occur
while the mother is recovering from her emergency cesarean section
(EmCS) due to cervical prolapse. The severity of the mother's
cervical prolapse is unknown; hence conservative interventions such
as Kegel's exercise may or may not be effective. In a study about
pelvic floor exercises, 3 and 10 out of 100 women decided to have
the surgery after all (Institute for Quality and Efficiency in Health
Care, 2021). A surgical procedure is required for severe cases of
pelvic organ prolapse wherein the pelvic floor cannot be restored to
its normal state (Vargas et al., 2022). However, a prolapse
recurrence may still arise even after the surgery (Institute for Quality
and Efficiency in Health Care, 2018).

If pelvic organ prolapse is left untreated, it may impair potential

pregnancy and increase the chances of infection and injury to the
pelvic organs (Albowitz et al., 2014).

Sources:
Albowitz et al., (2014)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4210379/

Institute for Quality and Efficiency in Health Care (2021)

https://www.ncbi.nlm.nih.gov/books/NBK525762/

Institute for Quality and Efficiency in Health Care (2018)

https://www.ncbi.nlm.nih.gov/books/NBK525780/

Vargas et al., (2022)

https://www.sciencedirect.com/science/article/pii/S221491122200041
8#bb0015

1
4. Salience of 2/2 x 1 The family perceived the condition as needing immediate attention.
the They are aware of the mother's cervical prolapse but do not have a
Problem good understanding of the risk. Pelvic floor disease knowledge is
correlated with educational attainment as well as with a lack of
understanding that pelvic floor diseases are a medical issue,
according to research published in the British Journal of Pelvic and
Women's Health, knowledge of pelvic floor diseases is correlated
with educational attainment as well as with a lack of understanding
that pelvic floor diseases are a medical issue. Early treatment is
hampered by patient education and frequent screening by family
physicians. As prolapse treatment options expand, there is a need for
more awareness and education among women and professionals
regarding these options as a primary therapy and preventative
approach. 41%–50% of 40-year-old women have prolapsed uterine
 walls.

Sources:
Chiara Ghetti, MD (2020)
Knowledge of Pelvic Floor Disorders Among Pregnant and
Postpartum… (reliasmedia.com)

Abhyankar (2019)
Women’s experiences of receiving care for pelvic organ prolapse: a
qualitative study | BMC Women's Health | Full Text
(biomedcentral.com)

Total Score 3.34

C. Unhealthful Nutritional/Eating Habits

Criteria Computation Actual Justification

Score

1. Nature of 2/3 x 1 0.67 The problem is categorized as a health threat especially to the 3
the year old child of the family, the child has the risk of having
Problem malnutrition caused by lack of knowledge about proper nutrition and
eating habits. According to WHO, malnutrition refers to deficiencies,
excesses or imbalances in a person’s intake of energy and/or
nutrients. The term malnutrition covers 2 broad groups of conditions.
One is ‘undernutrition’—which includes stunting (low height for age),
wasting (low weight for height), underweight (low weight for age) and
micronutrient deficiencies or insufficiencies (a lack of important
vitamins and minerals) and based on data from UNICEF,
Everyday, 95 children in the Philippines die from malnutrition.
Twenty-seven out of 1,000 Filipino children do not get past their fifth
birthday. A third of Filipino children are stunted, or short for their age.
Stunting after 2 years of age can be permanent, irreversible and
even fatal.

Sources:
WHO (2020)
https://www.who.int/news-room/questions-and-answers/item/malnutri
tion

UNICEF (2014)
https://www.unicef.org/philippines/child-survival
 2
2. Modifiability 2/2 x 2 According to Encyclopedia on Early Childhood Development (2022)
of the Parents play a key role in promoting healthy eating. Right from the
Problem start, choosing to breastfeed gives babies a nutritional boost and
may help them learn to better regulate their food intake.

Many children continue to consume alarmingly low amounts of fruit,

vegetables, and important micronutrients, According to National
Surveys. The likelihood of micronutrients deficiencies such as iron
deficiency, anemia is increased by these poor dietary patterns.
Parents can also provide healthy nutritious food daily, such as fruits
and vegetables. Make mealtime an enjoyable time free of stress and
distractions. Best way for parents to encourage healthy eating is by
being a good role model.

Sources:
Black, M., and Hurley, K. (2013)
https://www.child-encyclopedia.com/child-nutrition#what-role-parents
-childrens-healthy-eating

https://www.child-encyclopedia.com/child-nutrition/according-experts/
helping-children-develop-healthy-eating-habits

1
3. Preventive 3/3 x 1 Problems from being undernourished, specifically malnutrition, is
Potential highly preventable if there is a nutrition-related education for all and
a safe and supportive environment for nutrition at all ages. According
to WHO, unhealthy diets and poor nutrition can lead to overweight
and obesity, noncommunicable disease (NCDs) such as heart
attacks and stroke, and are often linked with high blood pressure,
certain cancers, and diabetes. Also, approximately 45% of deaths
among children under the age of five is due to undernutrition, if
proper nutrition is provided, these cases will be reduced.

Sources:
WHO 2021
https://www.who.int/news-room/fact-sheets/detail/malnutrition

0
4. Salience of 0/2 x 1 The family’s daily meals are usually only composed of meat, and
the fruits can only be consumed 1-2 times per week. Also, they consume
Problem junk foods and soft drinks. They do not follow the appropriate diet for
each family's age. The family does not perceive the problem or
condition that requires change. They are unaware of the issue or the
potential consequences of consuming the same amount of nutrition
 and food for both mother and toddler. Just like many families, they
are not aware of, and do not use DOST programs such as "Pinggang
Pinoy", and there is a higher percentage of both undernutrition and
malnutrition. The nutrition that the adult is getting received is not
meant or intended for their 3-year-old child.

According to the study from DOST-FNRI, entitled Awareness of and

Adherence to the Food Based Dietary
Guidelines Among Household Meal Planners in the Philippines, data
shows that more than one-third of the meal
planners were aware of the DNGP (35.8%), and more than
one-fourth knew the Kumainments (27.5%). Only about
one in five (17.9%) was aware of the NGF, while Pinggang Pinoy®
(10.6%) is the least known of the respondents. Based on the results,
a large proportion of the respondents were not aware of the FBDGs.
Among those who were aware, only a minority had read the FBDGs.

Sources:
Madrid, et al. (2017)
https://philjournalsci.dost.gov.ph/images/pdf/pjs_pdf/vol147no3/

According to The World Bank, micronutrient undernutrition is highly

prevalent in the Philippines: 38% among infants six to 11 months old;
26% among children 12–23 months; and 20% of pregnant women
are anemic.

Sources:
WHO (2021)
https://www.worldbank.org/en/country/philippines/publication/

Total Score 3.67

The Prioritized Health Problems

The list of health conditions or problems ranked according to priorities is presented:

1. Potential for Enhanced Capability for Breastfeeding 4.5

2. Unhealthful Nutritional/Eating Habits 3.67

3. Presence of Health Threats related to 3.34

History of Childbirth Complication due to Cervical Prolapse

Part 2: Family Nursing Care Plan

 IV. Background of the Problem

Breastfeeding enhances health, reduces disease, and helps to lessen health disparities.

However, infants who are breastfed partially or not at all is a crucial public health problem.

According to UNICEF (2017), due to inadequate breastfeeding practices, over 2.8 million

Filipino children under the age of two were undernourished in 2015. As a result, over 7,500

Filipino toddlers die every year from undernutrition brought on by insufficient breastfeeding

practices. Also, children run a higher risk of dying from diarrhea and other diseases. Breast and

ovarian cancer risk can be increased for mothers who discontinued it. For the first six months of

life, breast milk gives a newborn all the nutrients necessary for healthy growth and

development. WHO is working to increase the rate of exclusive breastfeeding for the first 6

months to at least 50% by 2025. Dr. Rabindra Abeyasinghe, WHO Representative to the

Philippines, stated that "The Philippines' breastfeeding status needs to be improved so we may

accomplish and sustain the exclusive breastfeeding worldwide targets by 70% in 2030."

Activities such as those outlined in the "Global strategy for infant and young child feeding,"

which aims to protect, promote, and support appropriate infant and young child feeding, will help

to achieve this. WHO and UNICEF have developed courses to train health workers to provide

skilled support to breastfeeding mothers, assist them in overcoming challenges, and monitor

children's growth so that undernutrition or overweight/obesity can be identified early. Moving on,

The Expanded Breastfeeding Act (RA 10028 of 2009) is one of the evidence-based actions

recommended to improve breastfeeding rates. It supports paid maternity leave, encourages and

supports women to breastfeed in the workplace. If breastfeeding status improves, we'll be one

step closer to achieving our goals. Many of the Sustainable Development Goals—which include

improving nutrition (SDG2), preventing infant mortality and lowering the risk of
non-communicable diseases (SDG3), and promoting cognitive development and education

(SDG4)—can only be achieved by breastfeeding.

V. Family Nursing Diagnosis

a. Diagnosis

Potential for Enhanced Capability for Breastfeeding. According to the mother when

she was interviewed, she started breastfeeding her first child when he was born, breastfed 4-6

times a day and stopped when he was 1 and ½ years old. In her second child, she started

breastfeeding him when he was born, breastfed 4-6 times a day and stopped until the baby was

6 months old. Now, in her 3rd child, an infant, she started breastfeeding her 5 days after giving

birth and is still continuing up to this day. She breastfeeds her baby 4-6 times a day. When

asked if being not knowledgeable in breastfeeding is a problem that needs immediate attention,

the family answered “No”. With all the information gathered, it is concluded that the mother is

experiencing perceived insufficient breast milk production that resulted in stopping the

breastfeeding of her babies and did not consider it an issue that required immediate action.

According to WHO, exclusive breastfeeding is recommended for infants throughout the first six

months of life. Despite this, many mothers wean their kids due to a perceived lack of breast milk

supply.
b. Problem Tree Analysis
 VI. Family Nursing Care Plan

HEALTH GOAL OBJECTIVE ACTIVITIES EVALUATION

PROBLEM

Potential for Achieve an After 20 minutes 1. Assess the mother’s knowledge

Enhanced efficient of health and the extent of instruction
Capability for breastfeeding teaching, the provided about breastfeeding.
Breastfeeding regimen to mother will be
maintain able to 2. Encourage discussion of previous
and/or distinguish the breastfeeding experience.
increase milk benefits and
supply. contributing 3. Record unsatisfactory nursing
factors affecting experiences of the mother.
breastfeeding.
4. Do physical assessment of the
breasts.

5. Provide guidelines on recognizing

the signs and symptoms of a breast
infection.

6. Evaluate and record the infant's

ability to properly grasp and
compress the areola with lips,
tongue, and jaw.

7. Provide benefits and

sustainability for the mother and
child of effective breastfeeding
techniques.
After 20 minutes 1. Evaluate the mother’s motivation
of health to learn about breastfeeding .
teaching, the techniques.
mother will be
able to 2. Evaluate and record the mother’s
demonstrate ability to position, distinguish cues
effective and help the infant latch on.
breastfeeding
techniques by 3. Evaluate whether the infant is
showing at least satisfied after being breastfed or if
four the baby exhibits fussiness within
breastfeeding the first hour of breastfeeding.
positions

4. Explain and properly demonstrate

the proper breastfeeding
techniques.

5. Teach the mother about different

breastfeeding positions such as
cradle hold, cross cradle hold,
football hold and side lying.

6. Encourage the mother to gently

massage breast before and during
feedings.
After 20 minutes 1. Assess the patient’s readiness to
of health participate in fatigue-reduction
teaching the practices.
mother will be
able to express 2. Assess psychosocial stressors
psychological that may contribute to ineffective
comfort in breastfeeding.
breastfeeding
practice and 3. Provide education to the spouse
techniques. to support and assist the mother
during breastfeeding.
 VIII. Health Teaching Plan

Problem/ Topic: Potential for Enhanced Capability for Breastfeeding

Purpose: To provide the client with information necessary to understand the importance of

breastfeeding and achieve an efficient breastfeeding regimen to maintain and/or increase milk

supply, and to express psychological comfort in breastfeeding practice and techniques.

Goal: The client will comprehend the importance of breastfeeding, establish an effective

breastfeeding regimen to maintain and/or increase milk supply, and Express psychological

comfort in breastfeeding practice and techniques.

Objectives Content Outline Methods of Time Resources Methods of

Teaching Allotted Evaluation

After 1 hour of
health teaching,
the mother will be
able to:

1. Distinguish the Significance of Breastfeeding Lecture 20 PowerPoint Question and

benefits and to the Mother and Baby minutes Presentation answer
contributing Laptop
factors affecting White board
breastfeeding ● What is breastfeeding?
(COGNITIVE) ● Importance of
breastfeeding to mother.
● Importance of
breastfeeding to infants.

2. Demonstrate
Guide to Breastfeeding Demonstration 20 Baby doll Observation of
effective
minutes (dummy) Return
breastfeeding
● Proper breastfeeding Breast Demonstration
techniques by
techniques. dummy
showing at least
● Infant Feeding Cues
four breastfeeding
● Breastfeeding positions
positions.
- Cradle hold
(PSYCHOMOTO
- Cross cradle hold
R)
- Football hold
- Side lying
- Laid Back Position
 ● Breast and Nipple Care
● Pumping Breast Milk
● Storing Breast Milk

Concerns, Fears and Problems Discussion 20 Pen Feedback and

3. Express about Breastfeeding minutes Paper Self-evaluation
psychological Likert scale
comfort in ● Lack of accommodation of
breastfeeding Breastfeeding in Public.
practice and ● Physiological stressors
techniques. ● Maternal guilt a
(AFFECTIVE) ● t breastfeeding “failures”
References

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E., Calveley, E., Elders, A., McClurg, D., & Maxwell, M. (2019). Women’s experiences of receiving
care for pelvic organ prolapse: A qualitative study. BMC Women's Health, 19(1).
https://doi.org/10.1186/s12905-019-0741-2

Albowitz, M., Schyrba, V., Bolla, D., Schöning, A., & Hornung, R. (2014). Pregnancy after a laparoscopic
sacrohysteropexy: A case report. Geburtshilfe Und Frauenheilkunde, 74(10), 947–949.
https://doi.org/10.1055/s-0034-1383032

Black, M. M., PhD. (2013, September 1). Helping Children Develop Healthy Eating Habits. Encyclopedia
on Early Childhood Development.
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althy-eating-habits

Child nutrition. Encyclopedia on Early Childhood Development. (n.d.). Retrieved December 3, 2022, from
https://www.child-encyclopedia.com/child-nutrition#what-role-parents-childrens-healthy-eating

Child survival. UNICEF Philippines. (n.d.). Retrieved December 3, 2022, from

https://www.unicef.org/philippines/child-survival

Facts About Nationwide Breastfeeding Goals. (2022, August 3). Centers for Disease Control and
Prevention. https://www.cdc.gov/breastfeeding/data/facts.html

Fact sheets - Malnutrition. (2021, June 9). World Health Organization. Retrieved December 3, 2022, from
https://www.who.int/news-room/fact-sheets/detail/malnutrition

Hundreds of mothers gather to celebrate National Breastfeeding Awareness Month (n.d) UNICEF.
Available at:
https://www.unicef.org/philippines/press-releases/hundreds-mothers-gather-celebrate-national-br
eastfeeding-awareness-month (Accessed: December 3, 2022).

InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care
(IQWiG); 2006-. Pelvic organ prolapse: Pelvic floor exercises and vaginal pessaries. 2018 Aug
23. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525762/

InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care
(IQWiG); 2006-. Surgery for pelvic organ prolapse. 2018 Aug 23. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK525780/

Kent, J.C., Prime, D.K. and Garbin, C.P. (2012) “Principles for maintaining or increasing breast milk
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Kenway, M. (2021, November 17). How to Avoid Your Uterine Prolapse Symptoms Worsening. Pelvic
Exercises. Retrieved from
https://www.pelvicexercises.com.au/uterine-prolapse-symptoms/?v=796834e7a283&c=cc3d3f1dd
0cf

Knowledge of pelvic floor disorders among pregnant and postpartum... Relias Media | Online Continuing
Medical Education | Relias Media - Continuing Medical Education Publishing. (2020, March 1).
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 https://www.reliasmedia.com/articles/145789-knowledge-of-pelvic-floor-disorders-among-pregnan
t-and-postpartum-women

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_the_food_based_dietary_guidelines.pdf

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The Journal of Maternal-Fetal & Neonatal Medicine, 27(3), pp. 297–302. Available at:
https://doi.org/10.3109/14767058.2013.807235.

Vargas, B. A., García, A. E., Mendoza, R. L., Sarmiento, C. A., & Vargas, E. H. (2022). Management of
pelvic organ prolapse during pregnancy: Case report. Case Reports in Women's Health, 35.
https://doi.org/10.1016/j.crwh.2022.e00421

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Opportunities for Nutrition Policy and Programming. World Bank.
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hilippines

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from https://www.who.int/news-room/questions-and-answers/item/malnutrition
Appendices

Appendix 1

Informed Consent

INFORMED CONSENT FORM

This informed consent form is for social service providers in the community of Marikina, whom we are

inviting to participate in a study to provide health care, promote health teaching, and reach vulnerable

populations. By participating in this interview, you are providing an important contribution to this

project.

Group 12 2BSN3

Pamantasan ng Lungsod ng Marikina

Community Health Nursing (NCM 104)

Part I. Information Sheet

I.a Introduction

We, 2nd year nursing students, currently enrolled at Pamantasan ng Lungsod ng Marikina, are inviting

you to participate in a collaborative interview concerning you and your family’s health. At the end of

this study, we will be able to create a health teaching plan for you and your family in collaboration with

the Marikina Health Office. And to give you time to reflect, you do not need to decide right away

whether you will participate or not. You can discuss this activity with anybody you feel comfortable

speaking to. If you have difficulties understanding it as we go over the details, feel free to call out our

attention so that we could discuss it further.

I.b Purpose of the activity

The purpose of this activity is to gather data on potential health problems in your family. This is to help

you manage these concerns, promote health awareness. prevent community health risks, and improve

lifestyle. To accomplish this, we intend to visit parents who have faced risk and learn about their

experiences.

I.c Participant Selection

You are being asked and have been chosen to take part in this activity because you are:

1. a beginning family with children below 5 years old, or with a pregnant mother;

2. not an extended family living in the same household;

3. not a relative of any of the group members; and most importantly

4. you are fully informed and are willing to get recorded and interviewed.

We sincerely believe that your cooperation in this activity will benefit all of us.

I.d Duration of the activity

The activity will be a series of interviews starting from October and will end in December 2022, which

will be conducted via house-to-house visitation. This will be enough to exchange and gather data, to

better understand your experiences, behavior and phenomenon.

I.e Risks and benefits

We would like to inform you that this activity will include personal questions and may contain sensitive

topics. If you wish to participate in the activity, we can provide different approaches in order to acquire

the desirable solution for the health problems that you and your family are experiencing.
I.f Confidentiality

Your responses to this interview will be kept confidential. The interview transcriptions, and any other

identifying participant information will be kept in google drive and intended emails, where only our

team has access to it, and will be kept just until the written study is accomplished. The participant's data

will be kept confidential, except in cases where the team is legally obligated to report specific incidents.

These incidents include, but may not be limited to, any personal incidents. Our team will make utmost

effort to ensure your privacy.

I.g Contact us

If you have anything in mind that concerns you, any clarifications, you may contact any of the

following persons:

Name: Maryelle Leila P. Rea Jashiel Cassandra E. Salamat

Email: mp.rea09@gmail. jashielcassandrasalamat9@gmail.com

Contact Number: 09564850395 09107296761

Part II. Consent Form Sheet

I have read the foregoing information, or it has been read to me. I have had the opportunity to

ask questions about it and any questions I have been asked have been answered to my

satisfaction. I consent voluntarily to be a participant in this activity.

Print Name of the Participant _____________________

Signature of Participant _________________________

Date_____________________

Day/month/year
Statement by the researcher/person taking consent:

I have accurately read out the information sheet to the potential participant, and to the best of

my ability made sure that the participant understands that the following will be done:

1.

2.

3.

I confirm that the participant was given an opportunity to ask questions about the activity, and

all the questions asked by the participant have been answered correctly and to the best of my

ability. I confirm that the individual has not been coerced into giving consent, and the consent has

been given freely and voluntarily.

A copy of this Informed consent has been provided to the participant.

Print Name of Student/person taking the consent_________________

Signature of Student/person taking the consent___________________

Date_____________________________

Day/month/year
 MAY KAALAMANG PAHINTULOT

Ang may kaalamang pahintulot na ito ay para sa tagapamahala ng serbisyong panlipunan sa mga komunidad

ng Lungsod ng Marikina. Inaanyayahan namin kayo na makilahok sa aktibidad sa mga programang

pangkalusugan, na naglalayon na magkaroon ang mga mamamayan ng kamalayang pangkalusugan, at

maabot ang mga pamilyang nangangailangan ng tulong medikal. Sa pakikilahok sa panayam,

makakapagbahagi kayo ng importanteng ambag sa proyektong ito.

Pangkat 12 2BSN3

Pamantasan ng Lungsod ng Marikina

Community Health Nursing (NCM 104)

I. Unang Parte : Information Sheet

I.a Introduksyon

Kami ang Second Year Students ng Pamantasan ng Lungsod ng Marikina. Kayo ay malugod naming

iniimbitahan na lumahok sa panayam ukol sa iyo at sa kalusugan ng iyong pamilya. Isasagawa ang

aktibidad na ito upang mabigyan kayo ng kaalaman tungkol sa inyong kalusugan. Maaari kang

magtanong sa ibang tao upang makapag desisyon kung ikaw ay makikilahok o hindi. Kung ikaw ay

may mga hindi maintindihan, magtanong lamang sa aming pangkat upang maipaliwanag at mabigyan

kayo ng impormasyon.

I.b Layunin ng aktibidad

Ang layunin ng aktibidad na ito ay magsagawa ng pangangalap ng datos tungkol sa mga potensyal na

problemang pangkalusugan na maaring mayroon sa iyong pamilya. Ito ay upang matulungan kang

pamahalaan ang iyong mga pangamba, isulong ang kamalayan sa usaping pangkalusugan, maiwasan
ang mga panganib na mula sa komunidad, at mapabuti ang pamumuhay. Upang maisagawa ito,

nilalayon naming bisitahin ang mga magulang na nahaharap sa isang panganib at magtanong tungkol sa

kanilang mga karanasan.

I.c Pagpili ng kalahok

Kayo po ay aming napiling anyayahan na makilahok sa aktibidad dahil kayo ay:

1. nagsisimulang pamilya na mayroong anak o mga anak na edad 5 pababa, o kasalukuyang

mayroong buntis sa pamilya;

2. hindi nakatira sa iisang bahay kasama ang extended family;

3. hindi kamag-anak ng sinuman sa aming pangkat; at ang pinaka mahalaga

4. kayo ay pumayag na makilahok sa recorded na panayam

Naniniwala kami na ang inyong kooperasyon sa aktibidad na ito ay magbebenepisyo sa ating lahat.

I.d Itatagal ng aktibidad

Ang aktibidad na ito ay bubuuin ng serye ng mga panayam na magsisimula sa Oktubre at matatapos sa

Disyembre 2022, na gagawin sa pamamagitan ng pagbisita sa bawat bahay. Ang panahong gugugulin

ay sapat na sa pangangalap ng datos upang lalong maintindihan ang inyong mga karanasan, pag-uugali,

at pangyayari na may kaugnayan sa inyong kalusugan.

I.e Panganib at benepisyo

Nais naming ipaalam na ang panayam ay naglalaman ng mga personal at maaaring sensitibong paksa.

Kung ninanais niyong makilahok sa aming aktibidad, kami po ay maghahanda ng iba't-ibang paraan

upang makuha ang mga nararapat na solusyon sa inyong problemang pangkalusugan.

I.f Pananatiling kompidensyal

Ang mga datos at impormasyon na ibabahagi sa panayam ay mananatiling kompidensyal. Ang

transkripsyon ng mga panayam at lahat ng impormasyon ng kalahok ay ilalagay sa Google Drive, at

mga intended emails na ang makakakita lamang ay ang aming pangkat. Ang aming pangkat ay

sinisiguro ang pribalidad ng inyong impormasyon.

I.g Makipag-ugnayan sa amin

Kung mayroon kang katanungan o anumang paglilinaw, maaari lamang na makipag-ugnayan sa

alinman sa mga sumusunod na tao:

Name: Maryelle Leila P. Rea Jashiel Cassandra E. Salamat

Email: mp.rea09@gmail. jashielcassandrasalamat9@gmail.com

Contact Number: 09564850395 09107296761

II. Pangalawang Parte: Consent Form Sheet

Nabasa ko ang mga sumusunod na impormasyon, o binasa sa akin ang impormasyon. Nagkaroon

ako ng pagkakataon magtanong tungkol sa mga nakasaad at ang aking mga katanungan ay

nasagot nang maliwanag. Pinahihintulutan ko na ako ay lumahok sa aktibidad na ito.

Pangalan ng kalahok_______________________

Pirma ng kalahok_________________________

Petsa__________________

Araw/buwan/taon
Pahayag ng mananaliksik/ taong kumukuha ng pahintulot

Nabasa ko nang maayos ang mga sumusunod na impormasyon sa potensyal na kalahok, at ginawa

ang lahat sa aking kakayahan na masigurong naunawaan ng kalahok ang mga sumusunod ay

inaasahan:

1.

2.

3.

Sinisiguro ko na ang kalahok ay nabigyan ng oportunidad na makapag tanong tungkol sa

aktibidad, at lahat ng katanungan ng kalahok ay nasagot nang tama at sa abot ng aking

kakayahan. Sinisiguro ko na ang kalahok ay hindi pinilit sa pagbibigay ng pahintulot at ito ay

binigay nang malaya at boluntaryo.

Nabigyan ng kopya ng pahintulot ang kalahok.

Pangalan ng mag-aaral/ Kumukuha ng pahintulot_________________

Pirma ng mag-aaral/ Kumukuha ng pahintulot___________________

Petsa_________________

Araw/buwan/taon
 Appendix 2

Interview Form
\
 Appendix 3

Consolidated Interview Results